Medical Malpractice

ER doctor not in health insurance network and billed me. Went to ER per primary phys. request to rule out?

a stroke. The hospital/er is in network. We got a bill from the ER doctor and EOB from insurance that says the doctor is not in network so his bill is mine to pay. How should I handle this...a letter to the doc? How is the patient to know what doctors in an ER accept their insurance and why was he allowed to treat without informing us that he doesn't accept our insurance and why is an ER doctor allowed to do this if he is working in a hospital that is in my network. This is med mutual and hosp is in OHIO The deductibles over. It ended up being an admission for brain cancer and the patient(my dad) died.

Public Comments

1. Medical billings can become nightmares. Hospitals may be in your network, but all the doctors working there may not be, which seems odd, since you'd assume they all be covered under the same network "blanket". Unfortunately, ER transactions, by nature are urgent, and billing is their last priority, though it clearly is important to the person footing the bill. You may have to pay the bill, but it would apply towards your deductible, so it isn't "lost" entirely. Talk to the ins co and they may let you pay in installments if it's large.
2. I had a similiar situation as a manager of an outpatient clinic. The Radiology group was not in the preferred provider group for one of out patients. I worked with the Chief Financial officier of the hospital to resolve. I think you should call the following folks at the hospital 1. billing manager 2. finance dept. Try to reach the CFO 3. The physicians employer. (many times they are independent contractors that the hospital employs).
3. all you need to do is claim it was a life threatening issue, and that you had felt like you were having a stroke and needed immediate attention. If they still refuse to pay the bill then threaten them that your going to the States Insurance Commissioner office and file a complaint